Bill may ease mail-order prescriptions requirement

April 27, 2013

Mail-order prescription drugs may have been designed to make the process more convenient and efficient, but it's done just the opposite for Molokai resident Jennifer Hawkins and her husband.

"My husband is disabled. It's so hard for us being on a small island to get the medication we need in the time we need it," said Hawkins.

Last year, her husband, who needs to take insulin every day, was scheduled to receive his supply in the mail. Instead of arriving at the Hawkins' door, the insulin sat at the post office, unrefrigerated. Insulin needs to be stored in a refrigerator no hotter than 46 degrees in order to maintain potency, according to the U.S. Food and Drug Administration. So by the time Hawkins picked up the insulin at the post office, it had been sitting at above room temperature for an indefinite amount of time and had to be sent back. She would have to wait days to receive another shipment.

"Fortunately for us, we had insulin stored so we had enough to get through, but for someone who isn't on top of managing their medication, it could've been a real problem," said Hawkins.

It wouldn't have been a problem if the Hawkins were allowed to get their insulin from the local pharmacy, Molokai Drugs Inc., said owner Kimberly Svetin.

"At our pharmacy, we have very strict standards. We keep refrigerated medicines in our refrigerator, not on the shelf, and we don't take it out until (the patient) comes in to pick it up," said Svetin. "But if you get it in the mail, you may forget to pick it up or it may get lost."

Svetin has been working with other local pharmacists, community groups and lawmakers to get legislation passed that would allow patients to opt out of the mandatory mail-order prescriptions.

House Bill 65, which would allow prescription drug beneficiaries to purchase medications from local pharmacists or alternative retailers like Walgreens, Costco or Walmart, cleared its last committee hearing Friday and will see a final floor vote by both houses of the Legislature on Tuesday.

Currently, all state and county workers and beneficiaries who are on "maintenance drugs," drugs that must be taken regularly to mediate ailments like high-blood pressure, asthma and diabetes, must get their drugs through the mail from the designated pharmacy - CVS?Pharmacy, or Longs Drugs. The mail-order prescriptions can also be picked up at a CVS or Longs store, but only during designated hours, said Svetin.

"It's not like Oahu where there's a pharmacy every mile. On Molokai . . . (and) on Maui it's very limited," said Svetin. "People need their medicines, and sometimes they need it now."

She added that the revenue from these mail-order prescriptions is going to a Mainland-based company, CVS Caremark Corp., when it could instead be redirected to stay within Hawaii. She said that over the last few years, Molokai Drugs' sales have dropped more than 10 percent, largely because of the mandatory mail-order prescriptions.

"Multiply that by dozens of pharmacies throughout (Hawaii) . . . that's a lot of money being taken out of our state," said Svetin.

A related bill, HB 62, which would prohibit pharmacy benefits managers, or PBMs, from marketing patients' medical health information without prior consent, passed through a conference committee Thursday and will be voted on by both chambers next week.

"(The bills) seek to correct the incredible imbalance between Mainland PBMs and local pharmacists," said West Maui state Rep. Angus McKelvey, who is chairman of the Consumer Protection & Commerce Committee.

"Local pharmacists are more worried about the people, where big pharmacies are more worried about the product," said McKelvey.

CVS could not be reached for comment Friday, but a spokeswoman for the company submitted testimony on HB 65 that argued mail-service pharmacies make prescriptions more affordable. Retail prices of generic drugs are 6.8 percent higher than mail-order prices, while retail prices for single-source brands are 11 percent higher, according to CVS spokeswoman Lauren Rowley. She also cited a 2012 Visante study that concluded that mail-service pharmacies would save the state $203 million over the next 10 years.

But there is debate as to whether or not mail-order saves the state money or ends up costing more, especially when considering how many prescriptions are wasted due to being lost, improperly handled or sent to the wrong address, according to Matthew DiLoreto, director of state government affairs for the National Community Pharmacists Association in Washington, D.C. The NCPA has been advocating anti-mandatory mail-order prescription laws for years, according to DiLoreto.

"There's definitely a national trend that state legislators are starting to pay attention to these issues and listening to how local pharmacies are frankly being abused by the PBM industry," said DiLoreto.

DiLoreto cited face-to-face interaction, personal relationships with pharmacists, less wasted medication and more money that remains in Hawaii as benefits of providing patients with the option to obtain their medications from local agencies.

"The common misconception is that we're trying to prevent or prohibit the use of a mail-order pharmacy, but that's not it," said DiLoreto. "(We) just want to give the patient the option to choose where they obtain their medication from."

New York and Pennsylvania have already passed laws that allow patients to opt out of mail-order prescription drugs, and a number of other states are currently negotiating similar legislation, said DiLoreto.